COMMENTARY

Weight Loss and Diabetes

Brianne N. Hobbs, OD

Disclosures

November 12, 2013

Viewpoint

Do the results of this study indicate that weight loss has no clinically significant benefits? An accurate response to this question requires a closer look at the results and methodology of this trial.

Although there was no statistically significant difference between the groups with respect to cardiovascular outcomes, the intensive intervention group did fare better in some meaningful ways. Fewer patients required insulin therapy, and more patients enjoyed a partial remission of diabetes compared with control patients -- both of which are certainly substantial benefits. Perhaps this study demonstrates the power of patient education and support groups, because this was the protocol for the control group.

Another potential explanation for the seeming lack of efficacy of weight loss was the small gap in weight loss between the groups. Initially, the gap in weight reduction between the intensive group and the control group was substantial (8.6% vs 0.7%); however, by the end of the study, the gap had narrowed to a mere 2.5% difference between the groups (6.0% vs 3.5%).

This study also provides evidence of the difficulty of sustained weight loss in patients with diabetes, because most patients were unable to maintain the targeted weight reduction.

The Look AHEAD study did not specifically investigate the effect of weight loss on the development or progression of diabetic retinopathy, for example, but this study is still applicable to many patients in our examination chairs. A greater awareness of all the challenges that face our patients encourages compassionate, comprehensive, patient-centered care.

Abstract

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